OCD As A Neurological Disorder

People with OCD, in fact people with severe mood disorders like OCD, depression, schizophrenia, bipolar disorder, and other afflictions of the mind, often feel, or are indeed, stigmatized. Why is that?

1. Mental disorders are impopular. This is partly understandable: they may lead to severe incapacitation, in social settings, and in terms of occupation. One can less fulfill the demands of society than ‘normal’ folks can. Fear is not something one usually is proud of. Ruminating in passivity and being inaccessible to others are vexing things for the patient.

2. Patients tend to hide their illness for a long time, before consulting a clinician. The reason: they don’t want to come over as someone who is ‘mad’. They invest an awful lot of time and energy in hiding their state of mind. They force themselves to ‘act’ sanely. For fear of being rejected by others, which is a very human way of feeling. This even goes so far in that parents who suspect that one of their offspring has mental problems, do everything possible to suppress ouward signs of those problems; they want their family to come over as perfectly normal. Which only aggravates the condition of the little patient. Seeking help is postponed indefinitely. Call it: living in denial. All of this is also understandable, people have a natural tendency to live according to generally accepted ‘laws of normality’.

3. A less understandable, perhaps even reprehensible way of dealing with mental disorders such as OCD is the way popular culture deals with them. At best, people with diseases of the mind are depicted as eccentrics, whose problems are trivialized, fun is poked at these. If you consider that mental illness can lead to becoming jobless, being ostracized from a family, getting evicted from one’s house, then all that trivializing suddenly comes over as pretty criminal. An OCD patient who suffers from hoarding, and can’t throw anything away, runs the risk of termination of his/her rent contract by the flat’s owners – because the latter don’t have any insight in illnesses such as this one, and may think that the patient is just a slob, a lazy misfit, a potential risk.

At worst, and this usually takes place in thriller and horror movies, folks with disorders of the mind are turned into ugly monsters who are compulsive collectors of their victim’s bones, or sociopathic rapists, stalkers, and killers, well, you know the score. Odd that I write this, because I like a good thriller myself. But I am in the fortunate position that I can discern very well between fact and fiction here, and thus I can bring in quite some relativism into my feelings. I am afraid many people, nice, normal people, can’t, and as a result they build their images re: mental disorders from things they see in the world of popular crime fodder.

Pop fiction regarding mental disorders very rarely correctly reflects modern clinical insights into these illnesses. Script writers cook a weird soup from all kinds of previous fairy tales and horror stories; reality is much more mundane and unadventurous, and not gross, as movies want us to believe.

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The upshot of all this: it would be a good thing, a step forward if those interested would first take the three points above to heart, and second would try to see OCD, depression, and schizophrenia as biological disorders, neurological diseases, much in the vein of Parkinson’s, or some dysfunction of motor neurons, so that people have movement impairments. OCD, depression, and schizophrenia all can be assessed with imaging techniques and other biochemical assessments, and then they show certain abnormalities in the brain – no hidden little Hannibal Lectors, mind, but alterations in brain structures, and the connections between them.

Severe depression is associated with a smaller hippocampus, a sea-horse shaped structure that is essential for one’s memory capacities and one’s moods. OCD usually is correlated with abnormalites in shape and volume of brain areas that are located in the frontal cortex, the striatum, the thalamus, and the connections between these regions.

If you look at it this way, you won’t have a hard time to let go of the concept of a ‘twisted, evil mind’, or ‘being possessed by the Devil’, or ‘mad, completely insane’.

The true stigma in mental illness lies in a wrong perception of mental disorders, that is being fuelled by fear of the unknown, fear of rejection, and by a wrongful depiction of these impairments in popular culture.

The recipe? Sorry, it’s so brief: talk about it, be open, and visit a good clinician ASAP. Hiding makes everything much worse, much like alcoholism never solved any real problem ever.